Blood sugar is high, and the heart is also sinful! Obese diabetics should pay more attention!

Blood sugar is high, and the heart suffers

Member of the Diabetes Prevention and Control Committee of the Chinese Preventive Medicine Association

He Zhongchen, chief physician of the Department of Endocrinology, Beijing Hepingli Hospital

The contraction and beating of the heart become the driving force of our human blood flow, providing sufficient blood flow for organs and tissues, and is the driving force for the human body to maintain metabolism. Once the heart becomes dysfunctional, the quality of life is greatly reduced. Protecting our hearts is one of the keys to our long and healthy lives. But there is one type of disease that is a huge threat to the heart and is often overlooked, that is, obesity-related diabetes.

Diabetic heart disease

Obesity-related diabetes mellitus has a high incidence

In the past 30 years, the obesity rate in the mainland, especially among young people, has increased year by year, and the incidence of diabetes has increased in parallel with it. In recent years, type 2 diabetes has grown rapidly in the mainland, and according to the latest data, there are 140 million adults with diabetes in the mainland, of which about 90% are type 2 diabetics. In the type 2 diabetes population, another 60% of the population is overweight or obese. Obesity can exacerbate insulin resistance and trigger type 2 diabetes, which in turn can exacerbate abnormal lipid metabolism and exacerbate obesity. The two cause and effect each other, forming a vicious circle, which triggers a series of metabolic disorders in the body. If this state is not effectively resolved, it will cause vascular and nervous system lesions, and damage to target organs, especially damage to the most important organ of our human body, the heart, and diabetic heart disease.

There are three main types of diabetic heart disease:

The first is coronary artery disease located on the surface of the heart, which is what we usually call coronary heart disease.

The second is microangiopathy, which refers to the microangiopathy within the myocardium caused by cardiomyopathy.

The third is arrhythmias caused by diabetic autonomic neuropathy.

Patients with long-term poor glycemic control, metabolic disorders, and relatively long medical histories are prone to diabetic heart disease. In recent years, it has been found that people with obesity-related diabetes are more likely to develop diabetic heart disease. The rejuvenation of obesity-related diabetic patients also leads to a younger trend of diabetes mellitus with cardiovascular disease, heart failure, arrhythmia, and sudden cardiac death.

Why does obesity-related diabetes cause heart disease?

It starts with obesity. A large number of research data confirm that most obese people have insulin resistance and hyperinsulinemia. Both of these points are responsible for accelerating the formation and hardening of coronary artery vascular plaques. On this basis, the continuous increase of blood glucose, the disorder of glycolipid metabolism, the appearance of glycotoxicity, lipotoxicity, triggering chronic inflammatory response, exacerbating oxidative stress damage, etc. occur. Under the joint action of this series of factors, coronary artery thrombosis, multiple stenosis, diffuse changes in myocardium, and then myocardial infarction, heart failure, and sudden death occur. In order to prevent the occurrence and development of such diseases, simply controlling blood glucose and lowering blood lipids cannot eliminate the effects on the heart.

The prevalence of type 2 diabetes with obesity or overweight, predominantly insulin resistance, has increased in recent years and is increasingly occurring in adolescents and young adults, so the sooner the heart is protected, the better. For those who are overweight or obese and have developed diabetes, establishing good eating habits, participating in age-appropriate exercise, and developing a reasonable weight loss plan to reduce the occurrence of insulin resistance are the key to preventing the occurrence of diabetic heart disease.

Cardiac autonomic neuropathy

One of the most common chronic complications of diabetes

Diabetic neuropathy is one of the most common chronic complications of diabetes, and it includes peripheral neuropathy and autonomic neuropathy. In the latter, due to the lesion of the autonomic nerve that innervates the heart, it is called cardiac autonomic neuropathy.

Diabetic autonomic neuropathy is caused by a combination of abnormal glucose metabolism and a variety of other factors. Foreign studies have shown that in type 2 diabetes, the incidence of diabetic autonomic neuropathy is about 30%.

The main manifestations of diabetic cardiac autonomic neuropathy are:

Tachycardia in the resting state, the heart rate is 90 to 130 times per minute; some diabetic patients often have orthostatic hypotension, that is, vertigo occurs when switching from sitting to upright position; there is no cause of arrhythmia, such as frequent early Bo, and some patients have palpitations, chest tightness, fatigue, heart rate acceleration and other manifestations when they have slight activity, which can be said to be exercise intolerance.

The danger of diabetic cardiac autonomic neuropathy is that patients have no typical symptoms when they develop angina or myocardial infarction and are prone to acute cardiovascular events during exercise. Because the symptoms of diabetic cardiac autonomic neuropathy are usually not easy to be detected, for diabetic patients with poor blood glucose control, a long course of disease, and accompanied by neuropathy symptoms, it is recommended to pay attention to changes in their heart rate and heart rhythm, regularly go to the hospital for evaluation of cardiac autonomic neuropathy, such as electrocardiogram, recumbent blood pressure and other examinations, and adjust the treatment plan under the guidance of a doctor.

Painless myocardial infarction

Some sugar friends have atypical symptoms of myocardial infarction

Many people with diabetes develop myocardial infarction without typical symptoms. Although not all myocardial infarctions caused by diabetes do not have typical symptoms, diabetics must be vigilant against painless myocardial infarction.

Typical symptoms of myocardial infarction are crushing pain or suffocation in the precordial area, retrosternal bone, or even radiating to the back of the shoulder.

Why do people with diabetes develop painless myocardial infarction?

The first reason is that in patients with diabetes with a long course of disease, the coronary artery blood vessels will form multiple branches at the same time to form hardening plaques, which will gradually worsen and lead to coronary artery stenosis; in patients without diabetes, myocardial infarction is mostly caused by single coronary artery stenosis. Therefore, once the diabetic painless myocardial infarction occurs, it is mostly diffuse myocardial changes, because the lesion myocardial area is large, and the heart function is very easy to be damaged quickly, so the incidence of diabetic painless myocardial infarction is mostly manifested by heart failure, such as dyspnea, shortness of breath, etc., covering up the symptoms of discomfort in the precordial area.

The second reason, diabetic patients are prone to autonomic neuropathy, so that patients have a disorder of perception of pain, resulting in no typical myocardial infarction symptoms. In addition, older patients themselves responded less badly to pain. At this time, myocardial infarction is often manifested as gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, etc., of course, the appearance of epigastric pain will also be related to the site of myocardial infarction. There are also some patients who have no symptoms or only mild discomfort, such as fatigue, until the symptoms worsen and the ecG in the hospital does not detect myocardial infarction.

Therefore, for patients with a relatively long history of diabetes and an older age, if there is unexplained breathing difficulties, dry cough, or digestive tract symptoms, or dizziness, fatigue suddenly aggravated, it is necessary to consider the possibility of myocardial infarction, must be paid attention to and timely medical treatment.

The pictures in this article are from the Internet

Edit || Dong Chao Wan Tao

The duty director || Fan Hongbo